Arizona Education Consortium Membership Application Form Form

Arizona Education Consortium

Membership Application

INSTITUTION CONTACT PERSON
Name (Last, First):
Title:
Institution:
Address:
City:		State:	Zip:
Work Phone:		Fax:
Email:		Cell Phone:
Website:
	Is your institution regionally accredited? Yes No Accrediting Body:
	Are you a private institution? Yes No
	Are you a public institution? Yes No
	Does your institution award the following (check all that apply)?: Certificate Programs Associate Degrees Bachelor Degrees Master Degrees Doctoral Degrees Others:
NOTE: The membership belongs to the institution. Institutions may have more than one representative at general meetings and may have more than one person active in the organization. Membership dues for 2009-10 are $250 for private institutions and $150 for public institutions.